The effects of increasing fruit and vegetable intake in children with asthma: A randomized controlled trial.

Abstract

A high fruit and vegetable (F&V) diet reduces asthma exacerbations in adults; this has not been examined in children to date. To investigate the effect of a 6-month, high F&V diet on the time to first asthma exacerbation in children with asthma, in a parallel-group, randomized, controlled trial. Children (aged 3-11years) with asthma, history of exacerbations and usual low F&V intake (≤3 serves/day) were randomized to the intervention (high F&V diet) or control group (usual diet) for 6months. The primary outcome was time to first exacerbation requiring medical intervention. Secondary outcomes included exacerbation rate, lung function, plasma TNF-α, CRP, and IL-6, faecal microbiota and peripheral blood mononuclear cell (PBMC) histone deacetylase (HDAC) activity and G-protein coupled receptor (GPR) 41/43 and HDAC (1-11) expression. 67 children were randomized between September 2015 and July 2018. F&V intake (difference in change (∆): 3.5serves/day, 95% CI: [2.6, 4.4] p<0.001) and plasma total carotenoids (∆: 0.44µg/ml [0.19, 0.70] p=0.001) increased after 6months (intervention vs control). Time to first exacerbation (HR: 0.81, 95% CI: [0.38, 1.69], p=0.569; control vs. intervention) and exacerbation rate (IRR: 0.84, [0.47, 1.49], p=0.553; control vs. intervention) were similar between groups. In per-protocol analysis, airway reactance z-scores increased in the intervention versus control group (X5 ∆: 0.76 [0.04, 1.48] p=0.038, X20 ∆: 0.93 [0.23, 1.64] p=0.009) and changes in faecal microbiota were observed though there was no difference between groups in systemic inflammation or molecular mechanisms. In the control group, CRP and HDAC enzyme activity increased, while GPR41 expression decreased. No adverse events attributable to the interventions were observed. A high F&V diet did not affect asthma exacerbations over the 6-month intervention, though warrants further investigation as a strategy for improving lung function and protecting against systemic inflammation in children with asthma.